Means and methods for determining risk of type-1 diabetes by serum protein biomarkers

ABSTRACT

The present invention relates to methods for predicting a risk of a subject for Type 1 diabetes (T1D) on the basis of expression levels of protein markers in a sample obtained from the subject. The present invention also relates to in vitro kits for use in said methods.

FIELD OF THE INVENTION

The present invention relates to the field of molecular diagnostics. More specifically the present invention relates to means and methods for predicting a risk of a subject for Type 1 diabetes (T1D).

BACKGROUND OF THE INVENTION

The measurement of islet cell autoantibodies is currently the principle means of identifying an emerging threat in developing Type 1 diabetes. The risks associated with the appearance of islet antibodies have been evaluated in depth, and overall the appearance of multiple biochemically defined autoantibodies correlates with progression to disease irrespective of genetic risk group or autoantibody combination. T1D is generally diagnosed at the point when the majority of the insulin producing beta cells in the pancreas have been destroyed, at which stage the patient is dependent on insulin supplements for the rest of their life. Methods to establish risk and potential onset are thus needed to gain insight in the disease etiology and design potential treatment/prevention strategies.

Proteomic analyses in the study of T1D have previously mostly addressed differences in sera from diabetic patients and non-diabetic subjects. Whilst in-depth comparisons of proteins in samples from healthy subjects and patients with T1D have distinguished the diseased state, the identification of changes preceding this aggressive autoimmune disease is important for disease prediction and prevention. Such markers could be used in the evaluation of risks and preventative treatments.

BRIEF DESCRIPTION OF THE INVENTION

The present disclosure is directed to methods and kits that useful for identifying the risk that an individual, particularly an individual having a HLAconferred risk for type 1 diabetes, will develop type 1 diabetes (T1D). The risk can be determined based on amounts of one or more of the protein markers disclosed herein.

In one aspect, the present disclosure is directed to a method of predicting, determining and/or monitoring a risk of and/or progression towards Type 1 Diabetes (T1D) in an individual. The method comprises the steps of

-   -   a) determining a protein marker profile in a sample obtained         from the individual, said profile comprising:         -   i) PROF1 and FLNA,         -   ii) SHBG,         -   iii) AFAM and APOC4, or         -   iv) IBP2, ADIPO, and CO2,     -   b) comparing the determined protein marker profile and a         corresponding control profile, and     -   c) responsive to the comparison, determining a prediction         corresponding to a relative risk of the individual developing         T1D or a stage of progression towards T1D.

In some embodiments, the profile of i) further comprises one or more protein markers selected from the group consisting of VASP, CFL1, ACTB, TAGL2 and TMSB4X. In some other embodiments, the profile of ii) further comprises one or more protein markers selected from the group consisting of CO8G, ZPI, BTD, CO5, and THBG. In some further embodiments, the profile of iv) further comprises one or both protein markers selected from SHBG, CO8G. In some still further aspects, any of the marker profiles set forth above may further comprise any one or more protein markers selected from those listed in Table 4 and/or Table 5.

According to some embodiments, the above-defined profiles of i) to iii) are used to predict the risk of T1D prior to seroconversion.

In some embodiments, the individual whose risk for developing T1D has a HLA-conferred risk for T1D.

In another aspect, the present disclosure is directed to an in vitro screening kit comprising one or more testing agents for testing a biological sample for a protein marker profile indicative of a risk of developing T1D, wherein said profile comprises:

-   -   i) PROF1 and FLNA;     -   ii) SHBG;     -   iii) AFAM and APOC4; or     -   iv) IBP2, ADIPO, and CO2.

In some embodiments, the kit comprises one or more testing agents which recognize the protein markers of profile i) and one or more further testing agents which recognize one or more protein markers selected from the group consisting of TAGL2, VASP, CFL1, ACTB, and TMSB4X.

In some other embodiments, the kit comprises one or more testing agents which recognize the protein marker of profile ii) and one or more further testing agents which recognize one or more protein markers selected from the group consisting of CO8G, ZPI, BTD, CO5, and THBG.

In some still other embodiments, the kit comprises one or more testing agents which recognize the protein marker of profile iv) and one or more further testing agents which recognize one or both protein markers selected from the group consisting of SHBG and CO8G.

In some further embodiments, the kit may comprise, in addition to the one or more testing agents set forth above, one or more further testing agents which recognize one or more protein markers listed in Table 4 and/or Table 5.

Other objectives, aspects, embodiments, details and advantages of the present invention will become apparent from the following figures, detailed description, examples, and dependent claims.

BRIEF DESCRIPTION OF THE DRAWINGS

In the following the invention will be described in greater detail by means of preferred embodiments with reference to the attached drawings, in which

FIG. 1 is a schematic presentation of the study design that depicts the manner in which the discovery was made. Using a prospective longitudinal serum sample collection from children with a HLA-conferred risk for type 1 diabetes, samples were selected on the basis of clinical outcome and the determined levels of type 1 diabetes associated autoantibodies. Serum samples were prepared for proteomics analysis by mass spectrometry. Comparisons were made between children that developed type 1 diabetes and their age, risk and gender matched controls. Two quantitative approaches were employed. Firstly with isotope tagged relative and absolute quantitative (iTRAQ) reagents, secondly using a label free approach.

FIG. 2 shows timing of the serum samples used, represented relative to the first detection of T1D-associated autoantibodies in years. The samples profiled for the T1D-developing children are represented by black diamonds. These include iTRAQ measurements (13 pairs) and label free measurements in two batches (LFQ1 and LFQ2, n=6 and 9 pairs respectively). For the comparison between children (healthy vs. type 1 diabetes developing) the analyses considered protein abundance throughout the series (184 vs. 184 age-matched samples), samples before (71 vs. 71 age-matched samples), and after detection of seroconversion (113 vs. 113 age-matched samples).

FIG. 3 is a schematic representation of the 8-plex iTRAQ labelling strategy. Pool reference channels were used to link iTRAQ comparisons between experiments.

FIG. 4A shows classification between T1D-developing subjects and age-matched controls on the basis of the abundance of APOC4 and AFAM. The top scoring pairs method was used, yielding a 91% success rate. Black triangles represent the controls and open squares represent the T1D-developing children (i.e. cases).

FIG. 4B illustrates relative abundance measurements for APOC4 and AFAM for the case and control subjects.

FIG. 5A illustrates receiver-operator characteristics on the basis of the differences between APOC4 and AFAM levels and the individual effect of these proteins alone. The combination of APOC4 and AFAM gave an area under the curve (AUC) of 0.89.

FIG. 5B illustrates APOC4 levels in cases and controls, before seroconversion and in antibody positive subjects vs. age matched controls.

FIG. 6 illustrates the receiver-operator characteristic (ROC) curve of the abundance of PROF1 and FLNA as detected three to six months prior to autoantibody seroconversion.

FIG. 7 illustrates the outcome of pathway analysis of differentially abundant proteins three to six months prior to autoantibody seroconversion, emphasizing the putative importance of these proteins in events preceding seroconversion. The abbreviations used in the figure refer to genes encoding the listed proteins.

FIG. 8A illustrates the receiver-operator characteristic (ROC) curve of the abundance of SHBG throughout the time series (AUC 0.74), while FIG. 8B illustrates SHBG vs. CO8G, ZPI, BTD, CO5, and THBG (AUC=0.80).

FIG. 9 illustrates the receiver-operator characteristic (ROC) curve of the abundance of SHBG vs IBP2, ADIPO, CO2, and CO8G (AUC=0.85) post seroconversion.

DETAILED DESCRIPTION OF THE INVENTION

In some implementations, the present disclosure is directed to methods, proteomic profiles and kits useful for determining or predicting the risk that an individual will develop Type 1 diabetes (T1D), or determining an individual's stage of progression towards T1D, or monitoring or predicting an individual's progression towards T1D. As is described, this risk can be assessed based on the profiles of several panels of protein markers whose applicability, in some embodiments, depends on whether known T1D autoantibodies have been detected.

In some important embodiments, a prediction of an individual's risk of developing T1D can be made prior to any signs of seroconversion. As used herein, the term “seroconversion” refers to the first detection of one or several T1D-associated autoantibodies against beta cell-specific antigens in serum. These include islet cell specific autoantibodies (ICA), insulin autoantibodies (IAA), glutamic acid decarboxylase 65 autoantibodies (GADA), islet antigen-2 autoantibodies (IA-2A), and zinc transporter 8 autoantibodies (ZnT8A). In some embodiments, the following cut-off values may be used for determining the presence or absence of the autoantibodies: ICA≧4 JDFU (Juvenile Diabetes Foundation units), IAA≧3.48 RU (relative units), GADA≧5.36 RU, IA-2A≧0.43 RU, and ZnT8A≧0.61 RU. Seroconversion may occur years, e.g. 1 to 2 years, before clinical diagnosis.

Typically, the individual whose risk for T1D is to be determined is a human subject, preferably a child or an adolescent. In some more preferred embodiments, said subject does not show any signs of seroconversion. As used herein, the terms “subject” and “individual” are interchangeable.

The herein identified predictive proteomic profiles apply in particular to individuals having a Human Leukocyte Antigen (HLA)-conferred risk for T1D. As used herein, the term “HLA-conferred risk for T1D” refers to a predisposition to T1D as determined on the basis of the individual's HLA genotype. In some embodiments, HLA-conferred susceptibility is assigned if the individual carries HLA-DQB1 alleles *02/*0302 or *0302. In the experiments conducted, T1D diagnosed individuals whose risk was HLA-conferred were compared with control subjects with the same susceptibility. Similarly in the implementation of this screen, control and pooled control reference may be employed.

As used herein, the term “proteomic profile” refers to a set of proteins in a biological sample at a given time. A proteomic profile changes continually in response to internal and external events. Thus, a proteomic profile may be used not only to predict an individual's risk of developing a disease at a given time but also to monitor any changes in the prediction or disease status e.g. in response to treatment or dietary or other changes in the individual's lifestyle. The term may be used interchangeably with the terms “protein expression profile”, “protein signature”, “protein marker profile”, and the like, as is evident to a person skilled in the art. Predictive protein markers identified herein include those listed in Table 1.

TABLE 1 Protein markers comprised in various protein marker profiles of the present disclosure Protein Abbreviation Protein name Protein ID ACTB Actin P60709 ADIPO Adiponectin Q15848 AFAM Afamin P43652 APOC4 Apolipoprotein C-IV P55056 BTD Biotinidase P43251 CFL1 Cofilin-1 P23528 CO2 Complement 2 P06681 CO5 Complement 5 P01031 CO8G Complement component P07360 C8 gamma chain FLNA Filamin-A P21333 IBP2 Insulin-like growth fac- P18065 tor-binding protein 2 PROF1 Profilin-1 P07737 SHBG Sex hormone-binding P04278 globulin TAGL2 Transgelin-2 P37802 THBG Thyroxine-binding globu- P05543 lin TMSB4X Thymosin beta-4 P62328 VASP Vasodilator-stimulated P50552 phosphoprotein ZPI Z-dependent protease Q9UK55 inhibitor

As used herein, the term “determining a protein marker profile”, and the like, refers to detecting, measuring, or otherwise assessing the level, amount, or proportion of one or more protein markers belonging to a given profile. Said determining may give a relative or absolute value representing the amount or level of said marker in a biological sample obtained from an individual whose marker profile and, eventually, the risk of developing T1D, are to be determined.

Suitable biological samples for use in accordance with the present disclosure include, but are not limited to, tissue samples (e.g. pancreatic samples), blood samples including whole blood, serum, plasma, peripheral blood mono-nuclear cells and any purified blood cell type, and urine samples. In essence, any biological protein-containing sample may be used for the present purposes.

The level or amount of a protein marker in a biological sample may be determined by a variety of techniques as is readily apparent to a skilled person. Non-limiting examples of suitable methods include mass spectrometry-based quantitative proteomics techniques, such as isobaric Tags for Relative and Absolute Quantification reagents (iTRAQ) and label free analysis, as well as selected reaction monitoring (SRM) mass spectrometry. Also, the level or amount of a protein marker may be determined by e.g. an immunoassay, spectrophotometry, an enzymatic assay, an ultraviolet assay, a kinetic assay, an electrochemical assay, a colorimetric assay, a turbidimetric assay, an atomic absorption assay, flow cytometry, or any combination thereof. Further suitable analytical techniques include, but are not limited to, liquid chromatography such as high performance/pressure liquid chromatography (HPLC), gas chromatography, nuclear magnetic resonance spectrometry, related techniques and combinations and hybrids thereof, for example, a tandem liquid chromatography-mass spectrometry (LC-MS).

As used herein, the term “increased expression” refers to an increase in the amount of a protein in a sample as compared with a corresponding control sample. Said increase can be determined qualitatively and/or quantitatively according to standard methods known in the art. The expression is increased if the amount of the protein in the sample is, for instance, at least about 1.5 times, 1.75 times, 2 times, 3 times, 4 times, 5 times, 6 times, 8 times, 9 times, time times, 10 times, 20 times or 30 times the amount of the same protein in the control sample.

As used herein, the term “decreased expression” refers to a decrease in the amount of a protein in a sample as compared with a corresponding control sample. Said decrease can be determined qualitatively and/or quantitatively according to standard methods known in the art. The expression is decreased if the amount of the protein in the sample is, for instance, at least about 1.5 times, 1.75 times, 2 times, 3 times, 4 times, 5 times, 6 times, 8 times, 9 times, time times, 10 times, 20 times or 30 times lower than the amount of the same protein in the control sample.

To determine whether the expression level or the amount of a protein marker is greater than or lower than normal, the normal amount of the protein marker present in a biological sample from a relevant control has to be determined. Once the normal marker amounts are known, the determined marker amounts can be compared therewith and the significance of the difference can be assessed using standard statistical methods. When there is a statistically significant difference between the determined marker amount and the normal amount, there is a significant risk that the tested individual will develop T1D.

In some further embodiments, the levels, amounts or relative ratios of one or more protein markers may be compared with a predetermined threshold value which is indicative of the risk of developing T1D. Statistical methods for determining appropriate threshold values will be readily apparent to those of ordinary skill in the art. The threshold value originates from a relevant control which may be a single individual not affected by T1D or be a value pooled from more than one such individual.

As used herein, the term “relevant control” refers to a control sample, control proteomic profile, or control value, preferably case matched with the individual whose risk for T1D is to be predicted. Case-matching may be made, for instance, on the basis of one of more of the following criteria: age, date of birth, place of birth, gender, predisposition for T1D, HLA status and any relevant demographic parameter. In some embodiments, said control sample or profile consists of a pool of, preferably case-matched, relevant control samples or profiles. In some embodiments, said control prolife or control value has been predetermined prior to predicting a risk of T1D in an individual in accordance with the present disclosure. In some other embodiments, determining said control profile or control value may be comprised as a method step in any of the predictive methods disclosed herein.

Optionally, before to be compared with the control sample, the protein marker levels are normalized using standard methods.

Receiver Operation Characteristic (ROC) curves may be utilized to demonstrate the trade-off between the sensitivity and specificity of a marker, as is well known to skilled persons. The sensitivity is a measure of the ability of the marker to detect the disease, and the specificity is a measure of the ability of the marker to detect the absence of the disease. The horizontal X-axis of the ROC curve represents 1-specificity, which increases with the rate of false positives. The vertical Y-axis of the curve represents sensitivity, which increases with the rate of true positives. Thus, for a particular cutoff selected, the values of specificity and sensitivity may be determined. In other words, data points on the ROC curves represent the proportion of true-positive and false-positive classifications at various decision boundaries. Optimum results are obtained as the true-positive proportion approaches 1.0 and the false-positive proportion approaches 0.0. However, as the cutoff is changed to increase specificity, sensitivity usually is reduced and vice versa.

As used herein, the term “false positive” refers to a test result which classifies an unaffected subject incorrectly as an affected subject, i.e. a subject having or predicted to develop a disease. Likewise, “false negative” refers to a test results which classifies a subject who has or will develop a disease incorrectly as an unaffected subject.

As used herein, the term “true positive” refers to a test result which classifies a subject who has or will develop a disease correctly as a subject having or predicted to develop a disease. Likewise, “true negative” refers to a test result which classifies an unaffected subject correctly as an unaffected.

In accordance with the above, the term “success rate” refers to the percentage-expressed proportion of affected individuals with a positive result, while the terms “false positive rate” and “false detection rate” (FDR) refer to the percentage-expressed proportion of unaffected individuals with a positive result.

The area under the ROC curve, often referred to as the AUC, is a measure of the utility of a marker in the correct identification of disease subjects, i.e. subjects who will develop T1D. Thus, the AUC values can be used to determine the effectiveness of the test. An area of 1.0 represents a perfect test; an area of 0.5 represents a worthless test. A traditional rough guide for classifying the accuracy of a diagnostic or predictive test is the following: AUC values 0.9 to 1.0 represent a test with excellent diagnostic or predictive power, AUC values 0.80 to 0.90 represent a test with good diagnostic or predictive power, AUC values 0.70 to 0.80 represent a test with fair diagnostic or predictive power, AUC values 0.60 to 0.70 represent a test with poor diagnostic or predictive power, and AUC values 0.50 to 0.60 represent a test with failed diagnostic or predictive power.

As described in the experimental part, the present disclosure is based on an analysis on a unique series of prospective serum samples from at-risk children collected in the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) study. The samples covered the time span from before the development of autoantibodies (seroconversion) through the diagnosis of diabetes. Healthy, persistently autoantibody-negative children matched for date and place of birth, gender and the HLA-DQB1-conferred genetic risk were chosen as controls. Children who eventually developed T1D are herein sometimes referred to as “cases”.

Quantitative analyses of the data resulted in identification of proteins that may be used to predict T1D risk and provide indications of disease onset prior to diagnosis and, surprisingly, even prior to seroconversion. The identified predictive protein marker panels may be grouped into three different categories on the basis of their temporal utility in predicting T1D risk.

A first identified temporal category of protein markers is based on changes in protein abundance prior to seroconversion, particularly 3 to 6 months prior to seroconversion. The expression of these proteins either increases or decreases before seroconversion. As is described in the Examples below, analyses of the receiver operator characteristics of the data provided good classification of the children en route to T1D with respect to their controls. To be more specific, in samples collected within a 6 months' time period prior to seroconversion, increased levels of PROF1 were observed with a consistency sufficient for observing an AUC of 0.85 in the ROC analysis. Further analysis revealed that the combination of PROF1 and FLNA provided an AUC of 0.88 (FIG. 6).

Thus, in an embodiment of the present invention, T1D risk prediction, preferably prior to seroconversion, is based on determining the protein marker profile of PROF1 and FLNA, and comparing the determined protein marker profile with that of a control. Increased expression of the protein marker profile with respect to the control marker profile is indicative of a risk of getting T1D.

Pathway analysis of differentially abundant proteins three to six months prior to autoantibody seroconversion revealed biochemical associations between PROF1, FLNA, TAGL2, VASP, CFL1, ACTB, and TMSB4X (FIG. 7). Thus, PROF1 and FLNA based classification of at-risk subjects and unaffected subjects may be improved by including any one of proteins markers TAGL2, VASP, CFL1, ACTB, and TMSB4X, either alone or in any combination, in the protein marker profile to be determined for predicting the risk of T1D.

A second identified temporal category of protein markers is based on changes in protein abundance, as compared to control levels, throughout the time series. In other words, these markers may be used for predicting the risk of T1D either before or after seroconversion. The expression of these proteins is either increased or decreased across the time series.

A first protein marker panel belonging to the second temporal category comprises SHBG either alone or in any combination with one or more of protein markers CO8G, ZPI, BTD, CO5, and THBG. According to the present results, the expression of SHBG was decreased while the expression of CO8G, ZPI, BTD, CO5, and THBG was increased in the T1D-developing children as compared with the expression levels in the control samples. On its own, SHBG gave an AUC of 0.74 but when used in combination with any one of CO8G, ZPI, BTD, CO5, and THBG, the AUC was improved to the order of 0.8 (FIGS. 8A and 8B).

Thus, in an embodiment of the present invention, T1D risk prediction is based on determining the protein marker profile of SHBG either alone in any combination with one or more of protein markers selected from the group consisting of CO8G, ZPI, BTD, CO5, and THBG, and comparing the determined protein marker profile with that of a control. Differences in the protein marker profile with respect to the control marker profile are indicative of a risk of developing T1D. These marker profiles are suitable for being utilized either in a time period prior to seroconversion or from the seroconverted state to diagnosis.

A second protein marker panel belonging to the second temporal category comprises APOC4 and AFAM. As is described in the Examples below, statistical analysis of clinical samples revealed that APOC4 and AFAM, preferably in combination, are protein markers remarkably effective in determining the risk of T1D with clinically acceptable detection and false positive rates. Herein, APOC4 and AFAM were consistently detected at disparate levels, lower and higher, respectively, in prospective samples of children who developed T1D. Taken together, a success rate of 91% with a false positive rate of 5% on the basis of APOC4 together with AFAM levels was determined (FIG. 4A). The ROC analysis of APOC4 in combination with AFAM gave an AUC of 0.87 (FIG. 5A).

Thus, in an embodiment of the present invention, T1D risk prediction is based on determining the protein marker profile of APOC4 and AFAM, and comparing the determined protein marker profile with that of a control. Differences in the protein marker profile with respect to the control marker profile are indicative of a risk of developing T1D.

A third identified temporal protein marker panel comprises proteins whose expression levels reflect the transition of the seroconverted state towards diagnosis. The present data analyses revealed that progression to T1D is characterized by decreasing IBP2 and ADIPO, and increasing CO2. Thus, seroconverted patients should be monitored for these protein markers as indicators of pre-disease severity and/or to identify any need for intervention, moreover, when taken together with the contrast provided together with SHBG and CO8G (FIG. 9).

Thus, in an embodiment of the present invention, T1D risk prediction is based on determining the protein marker profile of IBP2, ADIPO, and CO2, and comparing the determined protein marker profile with that of a control. Differences in the protein marker profile with respect to the control marker profile are indicative of a risk of developing T1D. In a further embodiment, said marker profile includes, in addition to IBP2, ADIPO, and CO2, either one or both of SHBG and CO8G.

In some embodiments, the above-defined protein marker panels may be used in any desired combination. Thus, a protein marker panel comprising PROF1 and FLNA and, optionally, at least one of TAGL2, VASP, CFL1, ACTB, and TMSB4X, may be used in combination with a protein marker panel comprising SHBG and, optionally at least one of CO8G, ZPI, BTD, CO5, and THBG, or with a protein marker panel comprising APOC4 and AFAM, or with a protein marker panel comprising IBP2, ADIPO, and CO2 and, optionally, one or both of SHBG and CO8G. Likewise, in some embodiments, a protein marker panel comprising SHBG and, optionally at least one of CO8G, ZPI, BTD, CO5, and THBG, may be used in combination with a protein marker panel comprising APOC4 and AFAM, or with a protein marker panel comprising IBP2, ADIPO, and CO2, and optionally one or both of SHBG and CO8G. Likewise, a protein marker profile comprising APOC4 and AFAM may be used in combination with a protein marker panel comprising IBP2, ADIPO, and CO2, and optionally one or both of SHBG and CO8G.

In some embodiments, assessing or predicting an individual's risk for T1D may be based on determining, in addition to the protein marker profiles set forth above, the level or amount of one or more protein markers set forth in Table 4 and/or Table 5 The selection of one or more of these additional protein markers to be used may depend on a variety of practical considerations such as availability of protein marker testing reagents or equipment.

In summary, using mass spectrometry based analysis of immuno-depleted sera, the present inventors have demonstrated for the first time serum proteomics profiles of the pre-diabetic transition all the way to the diagnosis, comparing profiles between children progressing to type 1 diabetes and healthy children. These results demonstrate shared and group specific longitudinal changes against a back-ground of wide subject heterogeneity, suggesting that components of the moderately abundant serum proteins may be indicative of the emerging threat of type 1 diabetes.

Optionally, the present methods may further comprise determining variations in the individual's proteomic profile at different time points in order to monitor, preferably prior to seroconversion, any changes in the development of the risk for T1D.

In some implementations, the present methods of predicting an individual's risk for T1D may further include therapeutic intervention. Once an individual is identified to have an increased risk for T1D, he/she may be subjected to, for instance, dietary or other changes in the individual's lifestyle.

In some further implementations, the herein identified panels of predictive protein markers may be used for screening new therapeutics or preventive drugs for T1D. In other words, the present panels may be used for assessing whether or not a candidate drug is able to correct the protein marker profile of an at-risk individual towards that of an unaffected individual. For example, individuals identified to have an increased risk for T1D on the basis of their protein marker profile belonging to either the first or second temporal category of predictive protein markers could be employed as targets in preventive vaccination trials or in trials aimed for identifying preventive agents, such as probiotics, for T1D.

In some still further embodiments and implementations, the herein identified panels of protein markers may be used for determining an individual's stage of progression towards T1D and/or for monitoring or predicting an individual's progression towards T1D. Said stage of progression may be a pre-seroconversion stage, e.g. 3 to 6 months pre-seroconversion or 9 to 12 months pre-seroconversion, or a post-seroconversion stage, e.g. 3 to 6 months prediagnosis, 9 to 12 months pre-diagnosis, or 15 to 18 months pre-diagnosis. Of the herein disclosed panels of protein markers, panel i), i.e. PROF1 and FLNA, optionally, with one or more protein markers selected from the group consisting of TAGL2, VASP, CFL1, ACTB, and TMSB4X, is particularly suitable for monitoring said individual's T1D progression at the pre-seroconversion stage and predicting progression to the post-seroconversion stage, e.g. such that said individual is predicted to face the post-seroconversion stage e.g. within 9 to 12 months or 3 to 6 months. The protein marker panel ii), i.e. SHBG, optionally, with one or more protein markers selected from the group consisting of CO8G, ZPI, BTD, CO5, and THBG, and/or the protein marker panel iii), i.e. AFAM and APOC4, may also be used as set forth above regarding the panel i) but, alternatively or in addition, they may also be used for monitoring said individual's T1D progression at the post-seroconversion stage or predicting progression to T1D diagnosis, e.g. such that said individual is predicted to face the T1D diagnosis e.g. within 9 to 12 months or 3 to 6 months. The panel iv), i.e. IBP2, ADIPO, and CO2, optionally, with one or both of SHBG and CO8G, is particularly suitable for monitoring said individual's T1D progression at the post-seroconversion stage or predicting progression to T1D diagnosis, e.g. such that said individual is predicted to face the T1D diagnosis e.g. within 9 to 12 months or 3 to 6 months.

In some still further implementations, the present disclosure relates to an in vitro kit for predicting, preferably before seroconversion, a risk of a subject for developing T1D. The kit may be used in any one of the methods of the present disclosure. Typically, the kit comprises one or more testing agents for testing a sample obtained from an individual whose risk for T1D is to be determined for any one or more of the protein marker panels disclosed herein-indicative of a risk of developing T1D. In some embodiments, the kit may comprise one or more testing agents which recognize a protein marker profile comprising:

-   -   i) PROF1 and FLNA, and, optionally, also one or more protein         markers selected from the group consisting of TAGL2, VASP, CFL1,         ACTB, and TMSB4X;     -   ii) SHBG and, optionally, also one or more protein markers         selected from the group consisting of CO8G, ZPI, BTD, CO5, and         THBG;     -   iii) AFAM and APOC4; or     -   iv) IBP2, ADIPO, and CO2 and, optionally, one or both of SHBG         and CO8G.

In some embodiments, the kit may also comprise testing agents for any protein marker, or a combination thereof, listed in Table 4 or 5.

The kit may also comprise a computer readable medium comprising computer-executable instructions for performing any method of the present disclosure.

It will be obvious to a person skilled in the art that, as technology advances, the inventive concept can be implemented in various ways. The invention and its embodiments are not limited to the examples described below but may vary within the scope of the claims.

EXAMPLES Example 1 Research Design and Methods

A schematic of the experimental design used in the identification of these markers is illustrated in FIG. 1. Detailed description of the proteomic measurements, samples and comparisons are provided in Example 2.

Subjects and Sample Collection

All children studied were participants in the Finnish DIPP study, where children identified as at risk for type 1 diabetes based on their HLA genotype were followed prospectively from birth. Venous non-fasting blood samples were collected from the children at each study visit. Sera were separated and stored at −70° C. within three hours from the blood sample collections. Serum islet cell autoantibodies (ICA) measurements were made as previously described. For ICA positive children, glutamic acid decarboxylase (GADA), tyrosine phosphatase-related protein antibodies (IA-2A), and insulin antibodies (IAA) were also determined.

Proteomic measurements were made on sera from 28 case children who developed type 1 diabetes during DIPP follow-up. Prospective serum samples (5-11 per child) were selected to represent different phases of T1D progression from autoantibody-negativity to seroconversion (SC) and further until the overt disease. A persistently autoantibody negative control child was matched with each case (typically in the order of seven samples per child), based on the date and place of birth, gender and HLA-DQB1 genotype. The prospective control serum samples were matched with the case samples by age at sample draw. Altogether 409 serum samples were analyzed, of which sera from twenty-six children (13 case-control pairs) were processed for iTRAQ analysis, and from thirty children (15 case-control pairs) for analysis using a label free approach (Table 2, FIG. 2).

TABLE 2 Summary of the children progressing to T1D whose samples were studied with proteomics See also Tables 3a b & c in Example 2 for more information on the cases and their matched controls. Number of Age at samples serocon- Age at analyzed HLA-DQB1 version diagnosis (case and Analysis ID Gender risk alleles (years) (years) control) Method D1 M *02, *03:02 1.3 2.2 7 & 7 iTRAQ D2 M *02, *03:02 1.4 4.0 7 & 7 iTRAQ D3 M *02, *03:02 1.3 3.9 7 & 7 iTRAQ D4 F *02, *03:02 1.5 3.3 7 & 7 iTRAQ D5 F *02, *03:02 3.4 7.0 7 & 7 iTRAQ D6 F *02, *03:02 0.5 4.0 7 & 7 iTRAQ D7 F *02, *03:02 0.6 4.1 7 & 7 iTRAQ D8 M *02, *03:02 1.0 4.4 7 & 7 iTRAQ D9 M *02, *03:02 2.5 3.6 7 & 7 iTRAQ D10 M *03:02, x 1.5 2.5 7 & 7 iTRAQ D11 M *03:02, x 1.3 4.0 11 & 9  iTRAQ D12 M *03:02, x 2.0 2.2 5 & 7 iTRAQ D13 M *03:02, x 3.5 5.5 7 & 6 iTRAQ D14 M *02, *03:02 6.1 8.8 7 & 8 LFQ D15 M *02, *03:02 2.6 8.3 6 & 7 LFQ D16 F *02, *03:02 1.0 10.0 6 & 6 LFQ D17 F *02, *03:02 5.0 7.7 7 & 7 LFQ D18 M *03:02, x 1.3 12.1 6 & 8 LFQ D19 F *03:02, x 1.3 8.6 7 & 8 LFQ D20 M *03:02, x 2.5 6.6 9 vs. 9 LFQ D21 M *02, *03:02 4.0 12.5 9 vs. 8 LFQ D22 F *02, *03:02 2.0 7.8 9 vs. 8 LFQ D23 F *02, *03:02 1.0 3.6 7 vs 7 LFQ D24 F *02, *03:02 1.4 8.6 8 vs 9 LFQ D25 F *02, *03:02 6.5 9.3 9 vs 8 LFQ D26 F *02, *03:02 2.2 9.2 7 vs. 7 LFQ D27 M *03:02, x 3.0 4.3 8 vs 6 LFQ D28 M *02, *03:02 1.3 3.8 8 vs 8 LFQ x ≠ *02, *03:01, *06:02/3

Sample Preparation

Serum samples were depleted of the most abundant proteins using immuno-affinity columns. Beckman-Coulter (IgY-12) and Agilent (Hu14) columns were used in this study, where the same depletion method was always applied to follow-up samples of each case-control pair.

Samples from twenty-six children were compared using the iTRAQ method, using twenty-seven paired/cross referenced 8-plex ITRAQ labelling schemes of the samples. For iTRAQ labelling, the samples were then processed in accordance with the manufacturer's protocol for 8-plex reagents

(ABSciex, Framingham, Mass., USA), then fractionated using strong cation exchange chromatography. The typical labelling scheme for the iTRAQ measurements was as indicated in FIG. 3, where a pooled reference was used to link experiments.

Samples from thirty children were compared using label free quantification (LFQ), with concentration and digestion performed in a similar manner as the iTRAQ samples, with the digests otherwise unfractionated prior to LCMS/MS. Two batches of analysis were made, namely LFQ1 (n=6 pairs) and LFQ2 (n=9 pairs).

LC-MS/MS Analysis

HPLC-tandem mass spectral analyses (LC-MS/MS) were made with a QSTAR-Elite time of flight instrument (TOF) and an Orbitrap-Velos Fourier transform (FT) instrument. For the analysis of iTRAQ labelled samples, the collision induced dissociation and higher-energy collisional dissociation modes were used to record positive ion tandem mass spectra for the QSTAR-Elite and Orbitrap-Velos, respectively. The label-free data were acquired with the Orbitrap-Velos using collision induced dissociation. Chromatographic separations were made with 150mm x 75 pm i.d. tapered columns packed with Magic C18-bonded silica (200A), using binary gradients of water and acetonitrile with 0.2% formic acid.

LC-MS/MS Data Processing

The iTRAQ data were analyzed using ProteinPilot™ software using the Paragon™ identification algorithm with a Human Swiss-Prot database (Aug. 18, 2011, 20245 entries). The database searches were made in thorough mode specifying 8-plex-iTRAQ quantification, trypsin digestion and MMTS modification of cysteine. ITRAQ ratios were calculated relative to the reference samples using ProteinPilot™.

The label-free data were analyzed with Proteome Discover version 1.3 (Thermo Scientific) together with Mascot (2.1, Matrix Science). The database search criteria were trypsin digestion, MMTS modification of cysteine, deamidation of N/Q and methionine oxidation, using the same database. The mass tolerance settings of 5 ppm for the precursors and 0.5 Da for fragments were used. For quantitative analysis, Progenesis software (version 4.0) was used for feature detection and alignment of the ion maps and calculation of intensity-based abundance measurements for each protein. To facilitate comparison of the label free data with the iTRAQ results, the intensity values of each protein was scaled relative to the median intensity of each protein across the paired case-control sample series.

Data Analysis

Serum proteomics differences between healthy children and those progressing to type 1 diabetes. Case-control abundance ratios were calculated for the paired samples. The ratios were log₂ transformed and used in rank product analysis (RP) as is well known in the art to identify differences either throughout the time series (n=28), prior to the detection of autoantibody seroconversion (n=23) and prior to diagnosis (n=28). The RP analyses were made with 10,000 times permutations, and a false discovery rate (FDR) of less than or equal to 5% was applied (Benjamini-Hochberg (BH) correction). The differences analyzed were made for the average case-control ratios at the following time intervals (selected on the basis of the similarity of the sample series used): throughout the time series; prior to seroconversion, i.e. 3 to 6 months, 9 to 12 months and the overall period; prior to diagnosis, i.e. 3 to 6 months, 9 to 12 months, within 1.5 years and overall. Additional statistical tests were made using the Wilcoxon Rank-sum test.

Serum proteomics changes in children progressing to type 1 diabetes. Spearman's rank correlation analyses were made to assess whether any of the protein profiles were correlated with the emergence of T1D. The analyses were made for the collected case—control abundance ratios of the paired samples. For this comparison there were eleven well matched pairs with samples before and after seroconversion (subjects D1, D4, D5, D9, D10, D11, D12, D14, D15, D17, D19). The analysis was repeated separately for the case and control subjects to reference ratios. To unify this analysis the age/time axis was scaled between birth and diagnosis (zero to one). A Spearman's correlation coefficient greater than 0.4 was considered as a valid weak correlation (p-value based on 10,000 permutations of the time axis. BH corrected FDR≦0.05).

Subject and status classification. The top scoring pairs (TSP) method was applied to identify whether combinations of the quantified proteins could classify the samples and subjects. The leave-one-out method was used for cross validation. The method was tested in terms of relative protein abundance throughout the time series, before or after seroconversion, as well as for the intra individual longitudinal changes putatively associated with seroconverted status. The within subject averaged log₂ protein relative abundance values were used for the time periods studied. In the preliminary data (ITRAQ and LFQ1) APOC4 was detected in 16 out of 19 subject pairs, the 16 were separately analyzed with the TSP method. The failure to quantify APOC4 in all children was attributed to differences in instrument performance rather than its absence.

Example 2 Supplemental Information on Samples Subjects and Samples

Details of serum samples obtained children progressing to type 1 diabetes (D) and their matched controls (C) are shown in Tables 3a, 3b, and 3c below.

TABLE 3a iTRAQ samples HLA- Time HLA- Case DQB1 Time from Control DQB1 Age at Sample risk Age at from T1D Ab + Sample risk sample/ name Gender alleles sample SC diagnosis ve name Gender alleles days D1_1 Male 02/ 193 −274 683 0 C1_1 Male 02/ 193 D1_2 0302 284 −183 592 0 C1_2 302 288 D1_3 375 −92 501 0 C1_3 367 D1_4 467 0 409 1 C1_4 465 D1_5 584 117 292 1 C1_5 557 D1_6 719 252 157 1 C1_6 743 D1_7 807 340 69 1 C1_7 932 D2_1 Male 02/ 122 −407 −1396 0 C2_1 Male 02/ 279 D2_2 0302 529 0 −989 1 C2_2 302 455 D2_3 724 195 −794 1 C2_3 552 D2_4 940 411 −578 1 C2_4 742 D2_5 1143 614 −375 1 C2_5 914 D2_6 1234 705 −284 1 C2_6 1107 D2_7 1446 917 −72 1 C2_7 1470 D3_1 Male 02/ 278 −195 −1145 0 C3_1 Male 2/ 278 D3_2 0302 740 267 −683 0 C3_2 302 559 D3_3 1004 531 −419 1 C3_3 636 D3_4 1110 637 −313 1 C3_4 722 D3_5 1146 673 −277 1 C3_5 925 D3_6 1308 835 −115 1 C3_6 1092 D3_7 1423 950 0 1 C3_7 1286 D4_1 Female 02/ 183 −370 −1016 0 C4_1 Female 02/ 190 D4_2 0302 299 −254 −900 0 C4_2 302 370 D4_3 453 −100 −746 0 C4_3 453 D4_4 553 0 −646 0 C4_4 547 D4_5 645 92 −554 1 C4_5 644 D4_6 756 203 −443 1 C4_6 730 D4_7 1199 646 0 1 C4_7 1192 D5_1 Female 201/ 87 −1169 −2462 0 C5_1 Female 201/ 92 D5_2 0302 547 −709 −2002 0 C5_2 302 567 D5_3 907 −349 −1642 0 C5_3 902 D5_4 1073 −183 −1476 0 C5_4 1092 D5_5 1256 0 −1293 0 C5_5 1296 D5_6 2187 931 −362 1 C5_6 2184 D5_7 2549 1293 0 1 C5_7 2571 D6_1 Male 201/ 673 479 −899 1 C6_1 Male 201/ 549 D6_2 0302 769 575 −803 1 C6_2 302 637 D6_3 944 750 −628 1 C6_3 727 D6_4 1047 853 −525 1 C6_4 913 D6_5 1271 1077 −301 1 C6_5 1090 D6_6 1364 1170 −208 1 C6_6 1273 D6_7 1450 1256 −122 1 C6_7 1452 D7_1 Female 201/ 733 532 −753 1 C7_1 Female 201/ 659 D7_2 0302 833 632 −653 1 C7_2 302 735 D7_3 964 763 −522 1 C7_3 910 D7_4 1087 886 −399 1 C7_4 1099 D7_5 1188 987 −298 1 C7_5 1275 D7_6 1265 1064 −221 1 C7_6 1464 D7_7 1402 1201 −84 1 C7_7 1653 D8_1 Male 201/ 1018 646 −643 1 C8_1 Male 201/ 640 D8_2 0302 1102 730 −559 1 C8_2 302 730 D8_3 1207 835 −454 1 C8_3 900 D8_4 1318 946 −343 1 C8_4 1101 D8_5 1410 1038 −251 1 C8_5 1255 D8_6 1486 1114 −175 1 C8_6 1465 D8_7 1590 1218 −71 1 C8_7 1640 D9_1 Male 201/ 102 −795 −1206 0 C9_1 Male 201/ 103 D9_2 0302 233 −664 −1075 0 C9_2 302 273 D9_3 392 −505 −916 0 C9_3 366 D9_4 567 −330 −741 0 C9_4 525 D9_5 654 −243 −654 0 C9_5 614 D9_6 897 0 −411 0 C9_6 923 D9_7 1086 189 −222 1 C9_7 1100 D10_1 Male 302 118 −446 −882 0 C10_1 Male 302 109 D10_2 201 −363 −799 0 C10_2 204 D10_3 280 −284 −720 0 C10_3 293 D10_4 371 −193 −629 0 C10_4 397 D10_5 663 99 −337 1 C10_5 670 D10_6 731 167 −269 1 C10_6 733 D10_7 927 363 −73 1 C10_7 922 D11_1 Male 302 98 −363 −1372 0 C11_1 Male 302 89 D11_2 188 −273 −1282 0 C11_2 208 D11_3 289 −172 −1181 0 C11_3 292 D11_4 370 −91 −1100 0 C11_4 360 D11_5 461 0 −1009 0 C11_5 454 D11_6 548 87 −922 0 C11_6 542 D11_7 743 282 −727 0 C11_7 738 D11_8 902 441 −568 0 C11_8 929 D11_9 1179 718 −291 1 C11_9 1272 D11_10 1261 800 −209 1 C11_10 1456 D11_11 1476 1015 6 1 D12_1 Male 302 160 −553 −731 0 C12_1 Male 302 132 D12_2 349 −364 −542 0 C12_2 302 D12_3 531 −182 −360 0 C12_3 386 D12_4 713 0 −178 1 C12_4 473 D12_5 807 94 −84 1 C12_5 665 C12_6 739 C12_7 903 D13_1 Female 302 271 −1022 −1739 0 C13_1 Female 302 293 D13_2 363 −930 −1647 0 C13_2 398 D13_3 488 −805 −1522 0 C13_3 494 D13_4 729 −564 −1281 0 C13_4 721 D13_5 917 −376 −1093 0 C13_5 910 D13_6 1897 604 −113 1 C13_6 1834 D13_7 2009 716 −1 1

TABLE 3b Label-free samples LFQ1 HLA- Time HLA- Case DQB1 Time from Control DQB1 Age at Sample geno- Age at from T1D ICA, Sample geno- sample/ name Gender type sample SC diagnosis JDFU name Gender type days D14_1 Male  02, 88 −2135 −3120 0 C14_1 Male  02, 97 D14_2 0302  1841 −382 −1367 0 C14_2 0302  1787 D14_3 2055 −168 −1153 0 C14_3 2045 D14_4 2383 160 −825 1 C14_4 2417 D14_5 2824 601 −384 1 C14_5 2827 D14_6 2915 692 −293 1 C14_6 3009 D14_7 3206 983 −2 1 C14_7 3184 D15_1 Male  02, 104 −839 −2927 0 C15_1 Male  02, 85 D15_2 0302  655 −288 −2376 0 C15_2 0302  638 D15_3 746 −197 −2285 0 C15_3 735 D15_4 2105 1162 −926 1 C15_4 2148 D15_5 2491 1548 −540 1 C15_5 2490 D15_6 2636 1693 −395 1 C15_6 2668 D16_1 Female  02, 284 −84 −3366 0 C16_1 Female  02, 272 D16_2 0302  368 0 −3282 0 C16_2 0302  359 D16_3 2930 2562 −720 1 C16_3 2759 D16_4 3112 2744 −538 1 C16_4 3122 D16_5 3203 2835 −447 1 C16_5 3288 D16_6 3650 3282 0 1 C16_6 3645 D17_1 Female  02, 280 −1560 −2515 0 C17_1 Female  02, 259 D17_2 0302  1469 −371 −1326 0 C17_2 0302  1485 D17_3 1644 −196 −1151 0 C17_3 1641 D17_4 1840 0 −955 0 C17_4 1856 D17_5 1989 149 −806 1 C17_5 2015 D17_6 2197 357 −598 1 C17_6 2198 D17_7 2710 870 −85 1 C17_7 2739 D18_1 Male 0302  368 −99 −4060 0 C18_1 Male 0302  387 D18_2 3133 2666 −1295 1 C18_2 3108 D18_3 3304 2837 −1124 1 C18_3 3297 D18_4 3513 3046 −915 1 C18_4 3485 D18_5 4235 3768 −193 1 C18_5 4207 D18_6 4332 3865 −96 1 C18_6 4396 D19_1 Female 0302  116 −355 −3008 0 C19_1 Female 0302  126 D19_2 285 −186 −2839 0 C19_2 279 D19_3 374 −97 −2750 0 C19_3 378 D19_4 2418 1947 −706 0 C19_4 2378 D19_5 2577 2106 −547 0 C19_5 2567 D19_6 2747 2276 −377 0 C19_6 2742 D19_7 2948 2477 −176 1 C19_7 2931

TABLE 3c Label-free samples LFQ2 HLA- Time HLA- Case DQB1 Time from Control DQB1 Age at Sample geno- Age at from T1D ICA, Sample geno- sample/ name Gender type sample SC diagnosis JDFU name Gender type days D20_1 Male *03:02, 179 −736 −2227 0 C20_1 Male *03:02, 191 D20_2 x 650 −265 −1756 0 C20_2 x 638 D20_3 748 −167 −1658 0 C20_3 714 D20_4 915 0 −1491 1 C20_4 910 D20_5 1811 896 −595 1 C20_5 1816 D20_6 2022 1107 −384 1 C20_6 1995 D20_7 2210 1295 −196 1 C20_7 2191 D20_8 2330 1415 −76 1 C20_8 2359 D20_9 2406 1491 0 1 C20_9 2557 D21_1 Male *02, 89 −1362 −4477 0 C21_1 Male *02, 91 D21_2 *03:02 1262 −350 −3465 0 C21_2 *03:02 1282 D21_3 1101 −189 −3304 0 C21_3 1449 D21_4 1451 0 −3115 1 C21_4 3836 D21_5 3875 2424 −691 1 C21_5 4024 D21_6 4049 2598 −517 1 C21_6 4200 D21_7 4254 2803 −312 1 C21_7 4382 D21_8 4344 2893 −222 1 C21_8 4564 D21_9 4525 3074 −41 1 D22_1 Female *02, 94 −642 −2736 0 C22_1 Female *02, 187 D22_2 *03:02 183 −553 −2647 0 C22_2 *03:02 550 D22_3 561 −175 −2269 0 C22_3 647 D22_4 645 −91 −2185 0 C22_4 733 D22_5 736 0 −2094 1 C22_5 2189 D22_6 2220 1484 −610 1 C22_6 2385 D22_7 2416 1680 −414 1 C22_7 2543 D22_8 2570 1834 −260 1 C22_8 2748 D22_9 2753 2017 −77 1 C22_9 2915 D22_10 2829 2093 −1 1 D23_1 Female *02, 96.00 −283 −1205 0 C23_1 Female *02, 122 D23_2 *03:02 181.00 −198 −1120 0 C23_2 *03:02 278 D23_3 281.00 −98 −1020 0 C23_3 466 D23_4 482.00 103 −819 1 C23_4 586 D23_5 580.00 201 −721 1 C23_5 1111 D23_6 1104.00 725 −197 1 C23_6 1306 D23_7 1301.00 922 0 1 C23_7 1663 D24_1 Female *02, 97.00 −358.00 −3032.00 0 C24_1 Female *02, 87 D24_2 *03:02 293.00 −162.00 −2836.00 0 C24_2 *03:02 275 D24_3 371.00 −84.00 −2758.00 0 C24_3 369 D24_4 455.00 0.00 −2674.00 1 C24_4 452 D24_5 2491.00 2036.00 −638.00 1 C24_5 2524 D24_6 2731.00 2276.00 −398.00 1 C24_6 2699 D24_7 2834.00 2379.00 −295.00 1 C24_7 2888 D24_8 3032.00 2577.00 −97.00 1 C24_8 3063 D24_9 3129.00 2674.00 0.00 1 C24_9 3247 D25_1 Female *02, 184.00 ####### −3224.00 0 C25_1 Female *02, 277 D25_2 *03:02 279.00 ####### −3129.00 0 C25_2 *03:02 1495 D25_3 1479.00 −902.00 −1929.00 0 C25_3 1831 D25_4 1847.00 −534.00 −1561.00 0 C25_4 2034 D25_5 2017.00 −364.00 −1391.00 0 C25_5 2162 D25_6 2220.00 −161.00 −1188.00 0 C25_6 2517 D25_7 2577.00 196.00 −831.00 1 C25_7 2706 D25_8 2745.00 364.00 −663.00 1 C25_8 2874 D25_9 3398.00 1017.00 −10.00 1 D26_1 Female *02, 88.00 −699.00 −3280 0 C26_1 Female *02, 71 D26_2 *03:02 467.00 −320.00 −2901 0 C26_2 *03:02 450 D26_3 555.00 −232.00 −2813 0 C26_3 546 D26_4 3074.00 2287.00 −294 1 C26_4 3089 D26_5 3140.00 2353.00 −228 1 C26_5 3283 D26_6 3224.00 2437.00 −144 1 C26_6 3446 D26_7 3326.00 2539.00 −42 1 C26_7 3656 D27_1 Male *03:02, 101.00 −980.00 −1450.00 0 C27_1 Male *03:02, 97 D27_2 x 738.00 −343.00 −813.00 0 C27_2 x 705 D27_3 901.00 −180.00 −650.00 0 C27_3 1089 D27_4 1091.00 10.00 −460.00 1 C27_4 1384 D27_5 1194.00 113.00 −357.00 1 C27_5 1559 D27_6 1277.00 196.00 −274.00 1 C27_6 1740 D27_7 1369.00 288.00 −182.00 1 D27_8 1465.00 384.00 −86.00 1 D28_1 Male *02, 188.00 −301.00 −1184.00 0 C28_1 Male *02, 169 D28_2 *03:02 307.00 −182.00 −1065.00 0 C28_2 *03:02 267 D28_3 405.00 −84.00 −967.00 0 C28_3 454 D28_4 656.00 167.00 −716.00 1 C28_4 677 D28_5 774.00 285.00 −598.00 1 C28_5 740 D28_6 1153.00 664.00 −219.00 1 C28_6 915 D28_7 1244.00 755.00 −128.00 1 C28_7 1104 D28_8 1364.00 875.00 −8.00 1 C28_8 1280

Sample Comparisons Paired Samples

The comparisons for the samples were mostly paired within a time window of 60 days, with but a few exceptions where a later sample was used. The samples where no pairing could be made were only used to gain an overview in the clustering of the expression profiles. For the analysis of selected time points the following grouping was made (based on the use of the paired case/control ratios) according to the ages and time intervals in Table 3a and Table 3b: The samples were grouped on the basis of collection time

-   -   i) 3 to 6 months pre-seroconversion;     -   ii) 9 to 12 months pre-seroconversion;     -   iii) 3 to 6 months pre-diagnosis;     -   iv) 9 to 12 months pre-diagnosis;     -   v) 15 to 18 months pre-diagnosis;     -   vi) Throughout the 18 months pre-diagnosis

Example 3 Results

The iTRAQ measurements detailed on average the quantitative comparison of 220 proteins, and in total 658 proteins were identified and quantified with two or more unique peptides. In comparison to reference concentrations and after excluding depletion targets these spanned a range of estimated concentrations of six orders of magnitude. With the analyses using a label free approach, 261 proteins were consistently detected and quantified with more than one unique peptide and spanned a similar dynamic range of detection. There were 248 proteins common to the two techniques.

Differences between the Serum Proteomes of Children who Developed T1D and their Age Matched Controls

For the subjects considered in this study, the children who developed T1D had lower levels of SHBG, APOC4, APOC2, and APOC1 than their age-matched healthy controls (FDR <3%) (Table 3).

In samples before seroconversion, lower levels of APOC4 and APOC2 and APOA were apparent in children developing type 1 diabetes than in their controls. Similarly, specific consideration of the samples 3 to 6 months prior to seroconversion was consistent with the lower levels of both IBP2, TSP4, APOC2 and APOC4, as well as a larger relative abundance of PROF1, FLNA, and TAGL2.

With similar analysis of the age matched post seroconversion data, several proteins were distinguished with a lower relative abundance, including SHBG, ADIPO, THBG, APOC4, APOC2, IBP2, APOC1, and APOC3 (FDR <5%, Table 4).

TABLE 4 Serum proteins detected at different levels between children progressing to type 1 diabetes and their matched controls Entry ID name Protein names col q-value P55056 APOC4 Apolipoprotein C-IV a−, b−, d−, e−, 0.000 g−, h−, j− P02655 APOC2 Apolipoprotein C-II a−, b−, d−, e−, 0.001 g−, h−, j− P18065 IBP2 Insulin-like growth factor-binding protein 2 d−, e−, j−, g− 0.009 P11226 MBL2 Mannose-binding protein C a−, e−, g−, j− 0.011 P07737 PROF1 Profilin-1 b+, c+, d+, h+ 0.000 P04278 SHBG Sex hormone-binding globulin a−, e−, g−, j− 0.002 P02654 APOC1 Apolipoprotein C-I a−, e−, j−, g− 0.031 P02656 APOC3 Apolipoprotein C-III a−, j−, g− 0.013 Q96KN2 CNDP1 Beta-Ala-His dipeptidase a+, e+, j+ 0.017 P21333 FLNA Filamin-A a+, d+, h+ 0.000 P00740 FA9 Coagulation factor IX g+, j+ 0.004 P02751 FINC Fibronectin b−, g+ 0.009 P05154 IPSP Plasma serine protease inhibitor g+, j+ 0.007 P12955 PEPD Xaa-Pro dipeptidase d−, h− 0.003 P32119 PRDX2 Peroxiredoxin-2 h−, e+ 0.005 P37802 TAGL2 Transgelin-2 d+, h+ 0.000 Q15848 ADIPO Adiponectin e− 0.000 P08519 APOA Apolipoprotein(a) h− 0.000 Q15582 BGH3 Transforming growth factor-beta-induced e− 0.019 protein ig-h3 P43251 BTD Biotinidase g+ 0.017 P04003 C4BPA C4b-binding protein alpha chain e+ 0.013 P02748 CO9 Complement component C9 e+ 0.010 P09172 DOPO Dopamine beta-hydroxylase e+ 0.000 Q9NPH3 IL1AP Interleukin-1 receptor accessory protein c+ 0.030 Q08380 LG3BP Galectin-3-binding protein e+ 0.012 P43121 MUC18 Cell surface glycoprotein MUC18 d− 0.049 Q6UXB8 PI16 Peptidase inhibitor 16 e− 0.018 Q15063 POSTN Periostin e− 0.005 P06702 S10A9 Protein S100-A9 i− 0.001 P02743 SAMP Serum amyloid P-component e+ 0.049 P35443 TSP4 Thrombospondin-4 d− 0.043 Q9UK55 ZPI Protein Z-dependent protease inhibitor i+ 0.036 a) Throughout, n = 28, b) Pre-seroconversion (PS), n = 23, c) 9 to 12 months PS, d) 3 to 6 months PS, e) Post seroconversion and <1.5 year pre-diagnosis (PD), n = 28, f) 15 to 18 months PD, n = 28, g) 3 to 6 months PD, n = 20, h) 3 to 12 months PS. i) at diagnosis, j) Post seroconversion (all)

Longitudinal Changes in the Serum Proteome of Children En Route to T1D

With the analysis of protein abundance ratios there were no significant correlations observed between the case-control ratios with time towards diagnosis. On the contrary, the case and control reference correlations gave a much clearer indication of the longitudinal changes in the serum proteome in both case and control. Distinct from the correlated proteins observed with both the case and control children (>0.4, FDR <0.05) were changes in the abundance of 26 proteins (14 increased and 12 decreased, FDR <5%, Table 5). This included proteins reported in Table 4, emphasizing their utility in assessing advancement of the disease.

TABLE 5 Longitudinal changes in serum proteins specific to T1D-developing children Average Average Unique Unique Peptides Average % Correlatio

Entry Peptides Label Sequence coefficient Protein names name Entry iTRAQ Free Coverage* (Spearman

Fetuin-B FETUB Q9UGM5 18 7 30 0.

Serum amyloid P-component SAMP P02743 32 9 37 0.

Clusterin CLUS P10909 70 35 43 0.

C4b-binding protein alpha chain C4BPA P04003 21 11 24 0.

C4b-binding protein beta chain C4BPB P20851 5 2 20 0.

Complement factor I CFAI P05156 50 44 48 0.

Inter-alpha-trypsin inhibitor ITIH4 Q14624 251 92 63 0.

heavy chain H4 Apolipoprotein C-IV APOC4 P55056 4 6 22 0.

Insulin-like growth factor- IBP3 P17936 12 13 27 0.

binding protein 3 Serum amyloid A-4 protein SAA4 P35542 5 10 22 0.

Complement component C8 CO8A P07357 51 35 38 0.

alpha chain Complement C1q subcomponent C1QB P02746 27 17 29 0.

subunit B Hyaluronan-binding protein 2 HABP2 Q14520 20 12 26 0.

Complement component C8 CO8G P07360 28 7 58 0.

gamma chain Transforming growth factor- BGH3 Q15582 17 10 24 −0.

beta-induced protein ig-h3 Ectonucleotide pyrophosphatase/ ENPP2 Q13822 11 4 12 −0.

phosphodiesterase family member 2 Poliovirus receptor PVR P15151 5 4 8 −0.

Vinculin VINC P18206 6 3 6 −0.

N-acetylmuramoyl-L-alanine PGRP2 Q96PD5 61 31 50 −0.

amidase Contactin-1 CNTN1 Q12860 8 1 9 −0.

L-lactate dehydrogenase B LDHB P07195 9 2 24 −0.

chain 46) Extracellular superoxide SODE P08294 7 4 28 −0.

dismutase [Cu-Zn] Apolipoprotein A-IV APOA4 P06727 189 97 74 −0.

Adiponectin ADIPO Q15848 13 3 33 −0.

Neural cell adhesion molecule 1 NCAM1 P13591 13 5 17 −0.

Insulin-like growth factor- IBP2 P18065 6 6 19 −0.

binding protein 2

indicates data missing or illegible when filed

A subset of proteins was identified were the absolute Spearman's correlation coefficient was greater than 0.4 (FDR<0.05) and not observed at or above these thresholds in the control subjects. The analysis was based on the changes observed in eleven children representing the samples before and after seroconversion (D1, D4, D5, D9, D10, D11, D12, D14, D15, D17, D19). The functional enrichment for these proteins is show in Table 6. Notably included in this list were the proteins ADIPO and IBP2, which were also detected as differentially abundant in the rank product analyses. The temporal change of these proteins could be used to assess increased risk, particularly in seroconverted subjects.

TABLE 6 GO annotations enriched in proteins increasing in the children, who progressed to type 1 diabetes Term P-Value Proteins FDR GO:0002526 acute inflammatory response 3.8E−04 P07357, Q14624, P04003, P05156, 0.3 P02746, P20851, P10909, P07360, P02743, P35542 GO:0019724 B cell mediated immunity  .6E−04 P07357, P04003, P05156, P02746, 1.0 P20851, P10909, P07360 GO:0006958 complement activation, classical 8.6E−04 P07357, P04003, P05156, P02746, 1.0 pathway P20851, P10909, P07360 GO:0016064 immunoglobulin mediated im- 8.6E−04 P07357, P04003, P05156, P02746, 1.0 mune response P20851, P10909, P07360 GO:0002455 humoral immune response mediated 8.6E−04 P07357, P04003, P05156, P02746, 1.0 by circulating immunoglobulin P20851, P10909, P07360 GO:0006954 inflammatory response 0.0010 P07357, Q14624, P04003, P05156, 1.3 P02746, P20851, P10909, P07360, P02743, P35542 Complement pathway 0.0013 P07357, P04003, P05156, P02746, 1.3 P20851, P10909, P07360 GO:0002250 adaptive immune response 0.0014 P07357, P04003, P05156, P02746, 1.7 P20851, P10909, P07360 GO:0002449 lymphocyte mediated immunity 0.0014 P07357, P04003, P05156, P02746, 1.7 P20851, P10909, P07360 GO:0002460 adaptive immune response based 0.0014 P07357, P04003, P05156, P02746, 1.7 on somatic recombination of immune recep- P20851, P10909, P07360 tors built from immunoglobulin superfamily domains GO:0002443 leukocyte mediated immunity 0.0018 P07357, P04003, P05156, P02746, 2.1 P20851, P10909, P07360 GO:0006952 defense response 0.0032 P07357, Q14624, P04003, P05156, 3.8 P02746, P20851, P10909, P07360, P02743, P35542 Innate immunity .0039 P07357, P04003, P05156, P02746, 3.8 P20851, P10909, P07360 GO:0006959 humoral immune response 0.0041 P07357, P04003, P05156, P02746, 4.8 P20851, P10909, P07360 GO:0002541 activation of plasma proteins 0.0041 P07357, P04003, P05156, P02746, 4.8 involved in acute inflammatory response P20851, P10909, P07360 GO:0002253 activation of immune response 0.0041 P07357, P04003, P05156, P02746, 4.8 P20851, P10909, P07360 GO:0006956 complement activation 0.0041 P07357, P04003, P05156, P02746, 4.8 P20851, P10909, P07360

Enrichment was calculated for proteins with an absolute Spearman's correlation coefficient of greater than 0.4 (FDR<0.05) that were not observed at or above these thresholds in the control subjects. A background of the 208 proteins detected for these analyses was used in the enrichment analysis. The protein names and detection details are indicated in Table 3.

Serum Proteomics Classification of the T1D-Developing Subjects

The top scoring pairs (TSP) method was applied to identify whether combinations of the quantified proteins could classify the samples and subjects. The leave-one-out method was used for cross validation.

TSP analysis for the subjects of iTRAQ and LFQ1 in which APOC4 was quantified (16 of 19) classified the children progressing to type 1 diabetes at a success rate of 91%; the area under the curve was 0.89. The classification was based on the combination of the relative levels of APOC4 and AFAM, which were lower and higher than in the controls, respectively (FIGS. 4A and 5A).

TSP analysis for the LFQ2 subjects demonstrated that SHBG in combination with other proteins gave good classification of the subjects throughout the time series (up to 94% success rate). Analysis of the label free data alone (LFQ1 and LFQ2) revealed that the combination of SHBG and BTD provided an AUC of 0.85 for the post seroconversion data, and 0.77 pre-seroconversion.

For the collected data SHBG provided areas under of the curve for received operator curves combinations of these markers were in the order of 0.75 to 0.81. These combinations included higher levels of the following throughout: THBG, CO8G, BTD, CO5, and ZPI.

Profilin 1 (PFN1) has been associated with inflammation and insulin resistance, and notably significant differences were detected both before and after seroconversion (decreasing in the latter case). Notably the a peak in profilin 1 was observed before seroconversion and pathway analysis of the differentially abundant proteins detected at this time period indicated functionally related proteins (FIG. 7). Indeed ROC characteristics of the combination of PROF1 and FLNA improved the AUC to 0.88. Collectively these findings reflect metabolic differences and changes preceding the diagnosis of type 1 diabetes. 

1-14. (canceled)
 15. A method of predicting, determining and/or monitoring a risk of and/or progression towards Type 1 Diabetes (T1D) in an individual, the method comprising: a) determining a protein marker profile in a sample obtained from the individual, said profile comprising AFAM and APOC4; b) comparing the determined protein marker profile and a corresponding control profile, and c) responsive to the comparison, determining a prediction corresponding to a relative risk of the individual developing T1D or a stage of progression towards T1D.
 16. The method according to claim 15, wherein the risk of T1D is predicted prior to seroconversion.
 17. The method according to claim 15, wherein the individual has a HLA-conferred risk of T1D.
 18. The method according to claim 15, further comprising: determining one or more protein markers selected from those listed in Table 4 and/or Table 5, comparing the determined protein markers and corresponding control markers, and responsive to the comparison, determining a prediction corresponding to a relative risk of the individual developing T1D.
 19. The method according to claim 15, wherein said comparison and determination of the prediction are performed by a processor of a computing device.
 20. The method according to claim 15, wherein said sample is a whole blood sample, a plasma sample, a serum sample, a sample comprising purified blood cells, a tissue sample, or a urine sample.
 21. An in vitro screening kit comprising one or more testing agents for testing a biological sample for a protein marker profile indicative of a risk of developing T1D, wherein said profile comprises AFAM and APOC4.
 22. The kit according to claim 21, further comprising one or more testing agents which recognize one or more protein markers selected from the group consisting of TAGL2, VASP, CFL1, ACTB, and TMSB4X.
 23. The kit according to claim 21, further comprising one or more testing agents which recognize one or more protein markers selected from the group consisting of CO8G, ZPI, BTD, CO5, and THBG.
 24. The kit according to claim 21, further comprising one or more testing agents which recognize one or more protein markers selected from the group consisting of SHBG and CO8G.
 25. The kit according to claim 21, further comprising one or more testing agents which recognize one or more protein markers listed in Table 4 and/or Table
 5. 